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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624486
Report Date: 09/26/2022
Date Signed: 09/26/2022 03:06:18 PM

Document Has Been Signed on 09/26/2022 03:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:HOUSTON, NICOLEFACILITY NUMBER:
343624486
ADMINISTRATOR:HOUSTON, APRILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 217-0267
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/26/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nicole HoustonTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Gagandeep singh met with the applicant, Nicole Houston, for a scheduled inspection. The applicant applied for license due to change of location. Previously, the applicant was licensed (343618072) at different location and has recently moved at this location.

During today's inspection, LPA inspected the house for health and safety hazards. The day care will be provided on ground floor in Day care area (left side of main entrance), Dinning area, Kitchen, Family room, Hallway, Bathroom in the hallway and the Backyard. Off limit areas are entire second floor and bedroom, Garage on ground floor. During inspection, LPA observed the applicant has all of the unused electrical outlet covered. The house has smoke alarm, carbon monoxide detector and fully charge fire extinguisher. There are no pools, spas or other bodies of water at the property. Per applicant, there no firearms in the house. Applicant has child protective gates installed to keep the children out of off limit areas. Per applicant, local fire department conducted an inspection this morning and approved for large family child care home. LPA observed the applicant has valid CPR training certificate until March 2023 and has completion certificate for Mandated reporter training, which is valid until February 03, 2024.

During today's inspection, LPA did not observe any hazard in the house and the house meets the requirements for the licensure. LPA informed the applicant that once the LPA received the approved fire inspection document from the fire department, the applicant will be approved for the license as of today. Copy of this report was reviewed and provided to the applicant.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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